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Summary
The HIV/AIDS epidemic
continues to be a major global
health challenge, but with U.S.
support and leadership, an
AIDS-free generation is within
reach.
HIV/AIDS impacts the overall
development in many of the
most vulnerable countries
because it undermines efforts
to reduce poverty, improve
access to education and
healthcare, address gender
inequalities and maintain
national security.
The U.S. is the largest funder of
HIV/AIDS programs worldwide
through support for the
Presidents Emergency Plan for
AIDS Relief (PEPFAR) and the
Global Fund to Fight AIDS,
Tuberculosis and Malaria
(Global Fund).1
HIV/AIDS
Overview
In 2011, approximately 34 million people worldwide, including 3.4million children under 15, were living with HIV/AIDS. However, the
number of new HIV infections and deaths from the disease are on the
decline in many of the hardest-hit countries.2
In 2011, 1.7 million people died of AIDS-related illnesses and 2.5
million people were newly infected with HIV.3 In fact, 39 countries have
seen new infections among adults decrease by more than 25 percent
between 2001 and 2011, and deaths from AIDS have fallen by one-
third in the past 6 years.4
The HIV/AIDS pandemic disproportionately affects sub-Saharan Africa,
where almost three out of every four new infections occur.5
Millions of HIV-infected individuals lack the treatment services they
need to survive and thrive. The number of children accessing
treatment is especially troubling, with only 28 percent of eligible
children on treatment compared to 54 percent of eligible adults.6
The majority of those living with HIV do not know they are infected. 7
Women represent more than half of all current cases of HIV. Women
also often have less power in relationships and during sexual
encounters, leaving them vulnerable to coercion and gender-based
violence. HIV/AIDS is the leading cause of death among women of
reproductive age.8
Stigma, discrimination, legal barriers and the violation of human rights
pose major obstacles for key populations including men who have
sex with men, sex workers and people who use drugs to access HIV
prevention, treatment and care services in many countries around the
world.
PEPFAR is the largest commitment by a nation to combat a single
disease internationally, both programmatically and scientifically.
Additionally, the U.S. is responsible for 72 percent of global spending
on HIV/AIDS research and development.9
The Global Fund was created in 2002 to raise and disburse large sums
of money around the world to prevent and treat AIDS, tuberculosis andmalaria, diseases that together kill 5 million people every year. An
innovative public-private partnership, the Global Fund leverages $2 for
every $1 invested by the U.S. government while maximizing impact by
working in close coordination with PEPFAR and other U.S. programs.
James Pursey
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Making Progress
As of the end of FY2012, U.S.
assistance directly supported
more than 5.1 million patients on
life-saving antiretroviral
treatment, and more than 46.5
million people with counseling and
testing programs.10
PEPFAR provided resources and
funding for the prevention of
mother-to-child HIV transmission
for more than 11 million HIV-
positive pregnant women, allowing
more than 230,000 infants to be
born HIV-free in FY2012. Globally over 57 percent of women received the necessary treatment and services
to reduce transmission from mother to child, up from 15 percent in 2005.11
As of December 2012, the Global Fund had provided HIV/AIDS treatment to 4.2 million people, as well as
services to 1.7 million pregnant women. On average, the Global Fund saves 100,000 lives each month with
its work on HIV, tuberculosis and malaria.
Recent scientific advances have reinforced the fact that putting HIV-positive individuals on treatment is not only
good for their own health, but also reduces the likelihood of transmission to others.
PEPFAR plays a fundamental role in reaching key populations with targeted services and creating an enabling
environment for working with stigmatized groups in both generalized and concentrated epidemics.
To ensure that countries are able to sustain and build on progress to date, PEPFAR programs continue to invest in
building strong health and community systems that increase national capacity to implement country-led HIV/AIDS
programs.
PEPFAR has begun to transition from an emergency response to one of long-term sustainability through
partnerships and country ownership. U.S. investment has been leveraged with other bilateral and multilateral
partners to create a truly global response.
U.S. Response and Strategy
Since President George W. Bushs announcement of PEPFAR in 2003, the U.S. has invested more than $40 billion in
the global AIDS response. The program was most recently reauthorized through the Tom Lantos and Henry J. Hyde
United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008.
Implemented through the Office of the Global AIDS Coordinator (OGAC) in the Department of State, PEPFAR is a
multiagency effort supporting HIV/AIDS programs mainly through USAID and the Centers for Disease Control and
Prevention, with additional programming through the Department of Defense, the Department of Health and HumanServices and the Peace Corps. The program works closely with other major bilateral and multilateral donors such as
the Global Fund.12
Scientific advances since the beginning of PEPFAR have improved how we respond to the global HIV/AIDS epidemic,
and in turn have made U.S.-funded programming more efficient and effective. The PEPFAR program now has a clear
plan how the U.S. government is going to lead the world towards the end of AIDS in the recent Blueprint Towards an
AIDS-Free Generation. The Blueprint has a simple goal: make smart investments based on sound science with a
shared global responsibility in order to achieve an AIDS-free generation.
Source: AIDSInfo
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Recommendations
Congress should maintain strong funding levels for the PEPFAR program. We recognize that these are
challenging economic times. However, U.S.-funded global HIV/AIDS programs have shown a consistent return on
investment measured in lives saved, costs avoided through infections prevented and the generation of goodwill
among global partners. Strong support from Congress, including policies that support the effectiveness of HIV/
AIDS programming, is critical to advancing the global AIDS response.
Congress should continue to support the Global Fund. Multilateral funding complements bilateral funding by
leveraging investments from other donors, helping build country-level commitment and strengthening capacity at
all levels to deliver programs. U.S. leadership has been and remains the most important leveraging tool available
to the Global Fund. In the lead up to the Fourth Replenishment of the Global Fund, scheduled for fall 2013, it is
critically important for the U.S. government to signal to the international community its continued strong support by
providing robust funding for the Global Fund in FY2014.
Support scientific advances towards the end of HIV/AIDS. Even with amazing strides toward ending the global
AIDS crisis, many undiscovered breakthroughs remain. A vaccine and a cure are on the horizon. New
technologies and treatments could be game changers. Ten years of global HIV/AIDS programming experience will
pave the way towards an AIDS-free generation if we can harness lessons learned. U.S. support for HIV/AIDSresearch is critical, not just for those suffering from and at risk for HIV/AIDS around the world, but also for the more
than 1 million people living with HIV in the United States.
Source: 2012 Country Progress Reports (www.unaidsorg
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Contributors
Elizabeth Glaser Pediatric AIDS Foundation
Katie Lapides Coester
International HIV/AIDS Alliance
Marielle Hart
International AIDS Vaccine Initiative (IAVI)
Jennie Aylward
1 Neglected disease R&D: A five-year review, G-FINDER, 2012. Pg. 28.2 Report on the Global AIDS Epidemic, UNAIDS, 2012. Pg. 8.3 Ibid. Pg. 8.4 Ibid. Pg. 11.5
Ibid. Pg. 11.6 Ibid. Pg. 47.7 Progress Report 2011: Global HIV/AIDS Response, WHO/UNAIDS/UNICEF, 2011.8 Women and Health: Today's Evidence Tomorrow's Agenda, The World Health Organization, 2009.9 Neglected disease R&D: A five-year review, G-FINDER, 2012. Pg. 28.10 World AIDS Day 2012 Update, PEPFAR. http://www.pepfar.gov/funding/results/index.htm.11 On the Road to an AIDS-Free Generation, Dipnote. http://blogs.state.gov/index.php/site/entry/on_the_road_to_aids_free_generation.12 Report on the Global AIDS Epidemic, UNAIDS, 2012. Pg. 11.
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